A physician friend once shared his belief that the main product of a physician’s productivity is the diagnosis. Setting aside feelings about the notion of a work product in medicine, I’ve quite liked the simplicity of his distillation. The diagnosis is the economic enabler which leads to tests, prescriptions, treatments, interventions and counseling.
So, what happens when patients can make their own diagnoses with the same, or better, accuracy?
That’s the question Innovation Hub Radio tackles in this week’s episode:
Question: What do insulin pumps, at-home pregnancy tests, and space medicine have in common?Answer: They can be administered without a doctor, and they might be the future of medicine.
—Innovation Hub Radio, WGBH
The recent dialogue about autonomy on this blog suggests moving more tools into the hands of patients is something many SPM members see as desirable. Further, one of SPM’s founders and past president, Alan Green, is helping Scanadu build what’s being touted as the medical tricorder. So certainly, these kinds of hard questions are in our DNA.
To that end, what happens to the patient-physician dynamic when the patient, not the physician, makes the diagnosis? Are there limits, technology aside, to what should be diagnosed at home? What responsibilities to patients have to themselves and their greater community when a diagnosis is made at home? And, to my friend’s comment about work product, what role do physicians play for patients who self diagnose accurately in the home?
I love this idea. It’s in practice today, as we all know, since “Googling it” is an ongoing topic in both patient and clinician circles … with a somewhat predictable disparity of POV, if you believe the headlines. (Which I do not recommend – always fact-check.)
Alan Greene has long been a bleeding-edge innovator among MDs, which ‘splains his success as a source of trustworthy medical info on the web, and also his involvement in the Scanadu project. Oh, and he also was one of the firestarters for SPM.
In short: I think the “dx at home” model will become the norm, and soon.
Flipping the clinic MUST include flipping what the phrase “see the patient” means. If I can offer up a data set that clearly shows I or my kid has strep – including a handy-dandy little home test kit that loads the data into my mobile device when the test is complete – then what’s the need for an office visit? Along with the potential to spread said strep like the gift that keeps on giving that it is?
I also see this as a boon for anyone with a chronic condition, since numbers on anything from pain to BP to O2 sats and more can be uploaded to one’s data-set, shared with a clinical team, and then treatment plans effected without having to drag oneself into an office for data capture.
So … what happens is faster care. The relationship between doctor and patient might shift a bit, but the participatory medicine model and/or the autonomy model will both be in effect. Mutual respect … for all!
A quick note from a two day meeting:
We who want to think about this must must must read Eric Topol MD’s books Creative Destruction of Medicine and his new The Doctor Will See You Now: the future of medicine is in your hands.
Alan points out that there’s a list of things doctors have provided throughout history. One has always been access to the medical literature; the internet has ended that as an “MD exclusive.” Tools like Scanadu’s are eroding diagnosis as an MD exclusive.
Note: this will not put doctors out of business! The better we get at managing our own health, and monitoring our status via for instance the devices Topol describes, the longer we’ll live! We’ll all get older and older. So if you want a booming future as a doctor, go into geriatrics.
But a lot of these machines have a vendor component: The data will not get to your doc without it first going to the supplier of the machine.
How do we get the vendor, who is sometimes obstructive, out of the way? (I don’t mind him looking over my shoulder, but I want primary control of my data.)
We seek the wisdom of doctors, not the data points we can accumulate.When we patients choose to gather these data points–a diabetic monitoring blood sugar, a drugstore shopper taking his blood pressure, a woman taking a pregnancy test, me weighing myself, and so on–we are accepting some responsibility for that data. We continue to have greater access to that data, and are trainable in assessing the meaning. Patients and doctors need blood lab measures that make comparisons of values, so as to better understand the impact of a treatment or the meaning of two values rising vs one of the two being stable. Some recent graphic designs of lab values do just that,and more will come, empowering all and speeding the diagnosis.
The Society to Improve Diagnosis in Medicine seeks to do just that, and involving patients at every step is essential. They take on the task of learning how to teach doctors to be aware of their own biases, mistakes and thinking processes.